• New research raises fundamental questions about progress on productivity goals required by Five Year Forward View
  • Kingsley Manning says “productivity is not a priority” at STP or trust level
  • No STPs provide analysis of workforce productivity, report finds
  • Lord Carter says progress is being made but “urgent” action is needed to build on this

The NHS will not deliver the ambitious productivity targets required by the Five Year Forward View based on current plans, a report by the former NHS Digital chair has warned.

Kingsley Manning’s report – the first in-depth analysis of how national, local and sustainability and transformation plans address Forward View’s productivity targets – has raised fundamental questions about the NHS’s long term sustainability.

Writing exclusively on hsj.co.uk, Mr Manning, who left NHS Digital last year and now works as a private consultant, said: “[My analysis] of how current performance and future plans at national, STP and trust level are performing on productivity suggests performance is falling woefully short of the rhetoric.

“In practice, productivity – particularly workforce productivity – is not a priority either at the level of the STP or for the major trusts.”

He said without a significant shake-up there were three likely outcomes:

  • the Forward View productivity targets would most likely be missed;
  • the NHS will continue to lag on productivity; and
  • “the inevitable digital revolution in healthcare will happen beyond the boundaries of the NHS, with potentially profound implications for its future role”.

The report comes as NHS England and its partners prepare to unveil the first system-wide update to the forward view since it was published in October 2014 next month. The Forward View was based on the NHS delivering a highly ambitious sustained 3 per cent annual improvement. Mr Manning said this would require a “step-change in workforce productivity” that had not yet materialised.

Manning report’s key findings

  • None of the 44 STPs provide analysis of current workforce productivity.
  • Ten STPs make no mention of productivity at all.
  • Only one of the 10 largest acute hospitals in England has implemented the Carter review’s interim recommendations (from February 2015) to report progress on unit costs.
  • Six STPs propose using RightCare data and Get it Right First Time methodology to identify performance improvements in hospital clinical acute care.
  • No STPs identify a basis for reviewing productivity in primary and community services.

System leaders have long been aware of the NHS’s productivity problems, and commissioned Lord Carter’s hospital productivity review, published in February 2016, to address them.

Lord Carter, who is now a non-executive director at NHS Improvement, warned “the biggest challenge for the NHS in 2016 is to deliver the changes needed to achieve the efficiency and productivity improvements required by 2020”.

Kingsley Manning

Kingsley Manning

Kingsley Manning said productivity is not a priority for trusts or STPs

His report highlighted numerous examples of how productivity could be improved, including the full meaningful use of digital systems already in place such as e-rostering systems. It also kicked off plans for a hospital efficiency league table, which has been delayed.

In response to Mr Manning’s findings, Lord Carter told HSJ good progress was being made with his reforms, but “urgent” action was required to make “productivity our core business”.

He said: “While there has been good work to deliver the recommendations at pace, we urgently need to build on this momentum to help the NHS meet this challenge by making productivity and efficiency improvements our core business.

“We have also seen some evidence that STPs are coming to grips with the productivity challenge by ensuring their infrastructure and planning breaks through old silos and better enables collaborative working, particularly in pathology and corporate services.

“However, there is an urgent need to deliver this across all STPs – one which NHS Improvement is supporting each day on its priority to consolidate pathology services and consolidate corporate services in order to have better value, higher quality services.”

'Woefully short' NHS will miss forward view targets, report warns